I receive many questions regarding coverage of outpatient therapy services by the Medicare program when the Medicare beneficiary is also receiving home health services. In this article, I will answer 7 of the more frequently asked questions I receive. Question Does the Medicare program pay for outpatient therapy services at the same time the Medicare beneficiary is receiving home health services? Answer Question If a Medicare beneficiary is receiving physical therapy and/or occupational therapy under an open home health episode of care and also requires speech therapy, but the home health agency does not provide speech therapy, will the Medicare

On June 25, 2020, the Centers for Medicare and Medicaid Services (CMS) released “Medicare and Medicaid Programs: CY 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Services Requirements“. Per the summary, “This proposed rule would update the home health prospective payment system(HH PPS) payment rates and wage index for calendar year (CY) 2021. This proposed rule alsoproposes to make permanent the changes to the home health regulations regarding the use oftechnology in providing services under the Medicare home health benefit as described in theMedicare and Medicaid Programs; Revisions in Response to

The Centers for Medicare and Medicaid Services has released a MLN Matters article that provides information on the continuing role of therapy under the newly implemented home health prospective payment system (HH PPS) case-mix adjustment methodology, named the Patient-Driven Groupings Model (PDGM), for home health periods of care starting on and after January 1, 2020. To access the article, click HERE. I hope you fond this article helpful.

On October 31, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Home Health Agencies for calendar year 2020. Highlights of the final rule include: CMS projects that aggregate Medicare payments to HHAs in CY 2020 will increase by 1.3 percent, or $250 million CMS will allow physical therapist assistants and occupational therapy assistants to provide maintenance therapy Home health episode of care will decrease for a 60-day episode to a 30-day episode Beginning in 2021, CMS will require HHAs to submit a notification to CMS within 5 calendar days from the start of care

The Centers for Medicare and Medicaid Services (CMS) has issued the Home Health proposed rule for calendar year (CY) 2020. In the proposed rule, there are several proposals that could have an impact on physical, occupational and speech therapy services with one of the proposals having a potential positive impact on outpatient therapy services and another proposal recommending changes to who can provide maintenance therapy to Medicare beneficiaries who are under an active Home Health Agency (HHA) plan of care. Proposals that impact therapy services include, but are not limited to the following:

Effective January 1, 2020, home health services will now be reimbursed under a new system called the Patient-Driven Groupings Model (PDGM). The PDGM changes the unit of payment from 60-day episodes of care to 30-day periods of care and eliminates the therapy thresholds for use in determining home health payment. Per the Centers for Medicare and Medicaid Services (CMS), the PDGM will assign 30-day periods of care into one of 432 case-mix groups based on the following variables: • Timing: The first 30-day period of care is an early period of care. The second or later 30-day period of care

A question I often receive is does the Medicare program pay for a Medicare beneficiary to receive outpatient therapy services while they are simultaneously receiving home health services under an open home health agency (HHA) plan of care? In this article, I will answer this question plus provide resources for the outpatient therapy provider to determine if the Medicare beneficiary is receiving home health services. The answer is